ENGLISH FAQ - Centro Bariatrico -
WHAT IS SEVERE OBESITY?
Severe obesity, sometimes known as ¨morbid obesity¨, is define as being approximately 100 pounds (45.5 kg) or 100% above ideal body weight. This is determined according to the metropolitan life Insurance Company height and weight tables. Between 3-5% of the United States adult population has severe obesity. This condition is associated with the development of life-threatening complications such as hypertension, diabetes and coronary artery disease, to name a few.
Numerous therapeutic approaches to this problem have been advocated, including low calorie diets, medication, behavioral modification and exercise therapy. However, the only treatment prove to be effective in long term manage-ment of morbid obesity is surgical intervention
WHAT CAUSES SEVERE OBESITY?
The cause of severe obesity is poorly understood. There are probably many factors involved. In obese persons, the set point of store energy is too high. This altered set point may result from a low metabolism with low energy expenditure, excessive caloric intake, or a combination of the above. There is scientific data that suggests obesity may be an inherited characteristic.
Severe obesity is most likely a result of a combination of genetic, psychosocial, environmental, social and cultural influences that interact resulting in the com,lex disorder of both appetite regulation an energy metabolism. Severe obesity does not appear to be a simple lack of self control by the patient
WHAT ARE THE TREATMENT OPTIONS?
MEDICAL TREATMENT
In 1991, the National Instituted of Health Conference conclude that non-surgical methods of weight loss for patients with severe obesity, except in rare instances, are not effective over long periods of time. It was shown that nearly all participants in any non-surgical weight-loss program for severe obesity regained their lost weight within 5 years.
Although prescriptions an non-prescription medications are available to induce weight loss, there does not appear to be a role for long-term medical therapy in the management of morbid obesity. Medications that reduce appetite can result in 11 to 22 pound weight reduction. However, weight gain is rapid once medication is withdrawn. Various professional weight loss programs use behavior modification techniques in conjunction with low calorie diets and increased physical activity. Weight loss of one to two pounds per week has been reported, but nearly all the weight loss in regained after 5 years.
SURGICAL TREATMENT
A number of weight loss operations have been devised over the last 40-50 years. The operations recognized by most surgeons include: vertical banded gastroplasty, gastric bypass (adjustable or non-adjustable), roux en Y gastric bypass, and mal absorption procedures (bilio pancreatic diversion, duodenal switch).
The vertical banded gastroplasty involves the construction of small pouch that restricts the outlet to the stomach. The outlet is reinforced with a piece of mesh (screen) to prevent disruption and dilatation.
The laparoscopic gastric band involves placing a ½ inch belt or collar around the top portion of the stomach. This creates a small pouch and a fixed outlet into the lower stomach. The adjustable band, which was approved by the FDA in jun 2001, can be filled with sterile saline. When saline is added, the outlet into the stomach is made smaller which further restricts food from leaving the pouch
The gastric bypass procedure involves dividing the stomach an forming a small gastric pouch. The new gastric pouch is connected to varying lengths of your own small intestine constructed into a Y-shaped limp (Roux-en-Y gastric bypass)
The malabsorption operations cause weight loss by decreasing absorption of calories from the intestines. These operations involve reducing the stomach size and bypassing most of the intestines.
Choosing between the different operative procedures involves the surgeon´s preference and consideration of the patient´s eating habits.
WHAT ARE THE ADVANTAGES OF THE LAPAROSCOPIC OBESITY SURGERY?
Advantages of the laparoscopic approach include:
• post-operative pain
• Shorter hospital stay
• Faster return to work
• improved cosmetics
WHO SHOULD BE CONSIDERED FOR LAPAROSCOPIC OBESITY SURGERY?
The following guidelines for selecting patients for obesity surgery were established by National Institute of Health:
- Patients should exceed ideal body weight by approximately 100 pounds (45.5 Kg) or 100% above ideals body weight.
- Patients should have no known metabolic (chemical breakdown of food into energy) or endocrine (hormone) causes for the morbid obesity.
- Patients should have an objectively measurable complication (physical, psychological, social, or economic) that might benefit from weight reduction.
This includes hypertension (high blood pressure), diabetes (too much sugar in the blood), heart disease, breathing problems or lung disease, sleep apnea (snoring and arthritis, just to name a few.
- The patient should understand the full importance of the proposed surgical procedure including suspected risks and complication.
- The patient should be willing to be observed and followed by a medical professional for many years.
- The patient should have attempted weight reduction using medical treatment without success
In some instances, a patient who is not quite 100 pounds or 100% above the ideal body weight is a candidate for surgical intervention. This patient should have a significant medical problem(s) that could benefit from weight reduction.
WHAT A PREPARATION IS REQUIRES?
• A thorough medical evaluation to determine if you are a candidate for laparoscopic obesity surgery by your physician.
• Supplemental diagnostic test may be necessary, including a nutritional evaluation.
• A psychiatric evaluation may be requires to determine the patient´s ability to adjust to changes after the operation.
• Consultation from specialists, such as cardiologist, pulmonologist or endocrinologist may be needed depending on your own specific medical condition.
• Continued participation in Obesity Support group is encouraged
• A written consent for surgery will be needed after the surgeon reviews the potential risk and benefits of the operation.
• The day prior to surgery, you will begin a clear liquid diet.
• Blood transfusion and/or blood products such as platelets.
• Your surgeon may request that you completely empty your colon and cleanse your intestines prior to surgery.
• It is recommended that you shower the night before or morning of the operation.
• After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
• Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
• Diet medication or St. John´s wort should not be used for the two weeks prior to surgery.
• Quit smoking and arrange for any help you may need at home.
HOW IS LAPAROSCOPIC OBESITY SURGERY PERFORMED?
In a laparoscopic procedure, surgeons use small incisions (¼ or ½ inch) to enter the abdomen trough cannulas (narrow tube-like instruments). The laparoscopic, which is connected to a tiny video camera, is inserted through the small cannula. A picture is projected onto a tv giving the surgeon a magnified view of the stomach an other internal organs. Five to six small incisions and cannulas are placed for use of specialized instruments to perform the operation.
The entire operations is performed inside the abdomen after expanding the abdomen with Carbon dioxide (CO2) gas, The gas is removed at the completion of the operation.
WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED BY THE LAPAROSCOPIC METHOD?
In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the ¨open¨procedure may include a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to angical judgment. The decisions to convert to an open procedure is strictly based on patient safety.